inquiry into use of cannabis for medical purposes€¦ · page 5 of 20 3. general health effects of...

Submission No 21

INQUIRY INTO USE OF CANNABIS FOR MEDICAL

PURPOSES Organisation: AMA NSW

Name: Mr Andrew Took

Date received: 14/02/2013

In regard to the Terms of Reference AMA (NSW) provides and adopts the current AMA (Federal) position statement on the medical uses of cannabis, which is outlined in the attached document

AMA is a medico-political organisation that represents over eight thousand doctors in training, career medical officers, staff specialists, visiting medical officers and specialists and general practitioners in private practice.

AMA (NSW) Submission Page 1 of 20

Parliament of New South Wales Legislative Council

General Purpose Standing Committee No.4

Inquiry into

Medical use of cannabis

Submission by

Australian Medical Association (NSW) Limited


Contents 1. Introduction………………………………………………………......

2. Cannabis Use in Australia…………………………………………… Page 4

3. General Health Effects of Cannabis…………………………………. Page 5

3.1 Short term effects of small doses……………………………………. Page 5

3.2 Short term effects of large doses……………………………………. Page 5

3.3 Long term effects……………………………………………………. Page 6

3.4 How long do the effects of cannabis last?............................................ Page 6

3.5 Pregnant Women…………………………………………………….. Page 7

3.6 Accidental ingestion by young children……………………………... Page 7

3.7 Driving under the influence of cannabis…………………………….. Page 7

3.8 Dependence and Tolerance………………………………………….. Page 7

3.9 Treatment Options…………………………………………………… Page 8

4. Cannabis as a Gateway Drug………………………………………... Page 8

5. Comparative Strength of Cannabis Compared with that used since

1970’s……………………................................................................... Page 8

6. Comparative Health Impact………………………………………… Page 8

7. Cannabis and Mental Health………………………………………… Page 9

7.1 Cannabis and Depression…………………………………………… Page 10

7.2 Cannabis and Anxiety……………………………………………….. Page 11

8. Medical Uses of Cannabis…………………………………………… Page 11

9. Cannabis and Legislation…………………………………………… Page 11

9.1 Criminalisation and Health………………………………………….. Page 12

9.2 Harm Reduction……………………………………………………... Page 12

10. Treatment Options…………………………………………………… Page 13

11. The AMA Position…………………………………………………... Page 13


12. Harm from Cannabis………………………………………………… Page 14

13. Cannabis and Mental Health………………………………………… Page 15

14. Responses to Cannabis Use………………………………………….. Page 15

15. Medical Uses of Cannabis…………………………………………… Page 17

References…………………………………………………………… Page 18


AMA is a medico-political organisation that represents over eight thousand doctors in training, career medical officers, staff specialists, visiting medical officers and specialists and general practitioners in private practice. In regard to the Terms of Reference AMA (NSW) provides and adopts the current AMA (Federal) position statement on the medical uses of cannabis set out below: 1. Introduction Cannabis is a drug that comes from the plant cannabis sativa12 The active chemical,

delta-9 tetrahydrocannabinol, (THC) is found in the resin that covers the flowering

tops and upper leaves in the female plant13. It is the THC that gives the user the

alteration in mood and the feeling of a ‘high’. Cannabis comes in three main forms:

marijuana, cannabis resin (hashish) and cannabis oil2,3 with the least potent form

being marijuana.

Cannabis can be smoked through a ‘joint’- a hand rolled cigarette containing matter

from the leaf, heads or resin of the plant or through a waterpipe or ‘bong’, where

water is used to cool the smoke before it is inhaled.

Cannabis is referred to as a ‘depressant’ drug in that it affects the central nervous

system, slowing down the messages between the brain and the body2.

2. Cannabis Use in Australia

In 2004, cannabis was the most commonly used illicit drug in Australia. One third

(33.6%, 5.5 million) of Australians aged 14 years and over had used it in their lifetime

and one in twenty (4.6%, 0.8 million) had used it in the last week.

Of the recent users of cannabis (0.8 million), one in six (16.4%, 131, 200) used it

every day and a further one in five (22.8%, 182,400) used it at least once per week.

For most people who use cannabis, their use is relatively light. The majority of young

people have used it once or twice4. However, the younger people start using cannabis

and the greater the frequency with which they use it, the greater the risk of harm.


3. General Health Effects of Cannabis

The effects of cannabis, as with all drugs, vary from one person to another based on

the person’s weight and health, degree of tolerance to the drug, what amount of the

drug is taken, and its interaction with other drugs2. Other influencing factors include

the frequency of use, age of onset of use, past drug experiences, the circumstances in

which the drug is taken, and the method used to absorb the drug.

3.1 Short term effects of small doses

Acute transient psychotic symptoms

Exacerbation of pre-existing psychotic symptoms

The most common short term effects of a small dose of cannabis are:

Impaired balance and coordination;

A ‘high’- with a tendency to talk and laugh more than usual;

Difficulties with memory retention and retrieval;

An increase in heart rate;

Decreased inhibitions such as being more likely to engage in risk behaviour eg

unsafe sexual practice and dangerous driving; and

If smoked, the effects on the lungs are similar to tobacco smoke. This can

make asthma and other respiratory problems worse.

These effects usually lead to feelings of slowing down and drowsiness.

A small number of people who use cannabis are very sensitive to its effects. The

effects can take the form of agitation, anxiety and panic, a sense of loss of control of

thoughts, feelings and sensations, or experiences of suspiciousness and paranoia.

3.2 Short term effects of large doses

The most common short term effects of a large dose are:

hallucinations;

vomiting;

feelings of panic or intense anxiety;

blacking out;


changes in perception of time, sound, colour, distance, touch and other

sensations;

restlessness, and

confusion.

3.3 Long term effects

If cannabis is taken on a regular basis over a long period of time then the following

health problems may be experienced:

tolerance- more of the drug is needed to produce the same effect;

increased risk of damage to lungs and lung functioning;

a decrease in motivation;

a decrease in concentration;

difficulties with memory and ability to learn new tasks;

decreased sex drive;

lowered sperm count in men;

irregular menstrual cycles in women; and

hyperemesis syndrome.

Consumption of large quantities of cannabis on almost every day of the week is likely

to lead to the neglect of some other important priorities such as relationships,

parenting, careers and community responsibilities5. However, there is currently a lack

of robust evidence for an amotivational syndrome (characterized by a loss of

motivation, energy and initiative) associated with the use of cannabis6.

3.4 How long do the effects of cannabis use last?

Intoxicating effects occur within seconds to minutes and can last for three

hours;

For larger doses the effects last longer;

Effects on thinking and coordination can last up to 24 hours;

Short term memory loss can last for a number of weeks; and

Complete elimination of a single dose in a chronic user can take up to 30 days.


3.5 Pregnant Women

Women who are pregnant and continue to smoke cannabis during pregnancy, as with

cigarette smoking, may have lower birth weight babies1. Cannabis is the most

commonly used illicit drug amongst women of child bearing age6. Cannabis use does

not appear to increase the risk of miscarriage, birth abnormalities or lower IQ. There

is some evidence to suggest that children who have been exposed to cannabis in utero

may have more difficulties with problem solving and maintaining attention, which

may compromise academic achievement6.

3.6 Accidental ingestion by young children

Young children can go into a coma after accidental ingestion of cannabis.

Confirmation of cannabis ingestion can be obtained by positive urine screening for

cannabinoids.

Medical practitioners need to consider cannabis ingestion in a toddler or child with

reduced consciousness levels and with or without abnormal neurological findings.

3.7 Driving under the influence of cannabis

Cannabis increases the risk of having an accident due to slow reaction time, blurred

vision, poor judgement and drowsiness. These effects can last several hours and vary

according to the quantity and quality of THC content and are increased by alcohol.

3.8 Dependence and Tolerance

Dependence on cannabis involves compulsive use but not usually physiological

dependence. The National Mental Health and Wellbeing Survey found that 2.2% or

300,000 of the adult Australian population had either abused or were dependent on

cannabis. This translated to approximately one in three of those who had used

cannabis in the last 12 months6. Dependence can negatively affect personal

relationships, education, employment and many other aspects of a person’s life.

Data from Australia and other countries indicates increasing demand for professional

help related to cannabis. In terms of tolerance, animal and human studies demonstrate

that tolerance to many of the psychological and behavioural responses to cannabis

occurs with repeated exposure to the drug. The withdrawal from cannabis appears


similar to that associated with tobacco but is less severe than withdrawal from alcohol

or opiates6

3.9 Treatment Options

Although the number of people seeking assistance for treatment of cannabis increases

and research indicates that cannabis can be addictive there has been little research on

the effectiveness of treatment options for cannabis misuse6.

4 Cannabis as a Gateway Drug

The gateway hypothesis is that the use of cannabis may act as a ‘gateway’ to the use

of other illicit drugs such as cocaine and heroin6. It is a controversial hypothesis with

proponents arguing that the use of so-called harder drugs is almost always preceded

by cannabis use7. The alternative theory to gateway is known as the ‘common cause’

theory whereby the use of cannabis and other illicit drugs is due to a range of

common causes such as socio-economic circumstances and personal factors6.

While current research suggests support for the gateway theory, more research is

required before this can be confirmed definitively. There is some conjecture that, as

most cannabis users have used cigarettes prior to cannabis, cigarettes act as a gateway

to cannabis use6.

5 Comparative Strength of Cannabis Compared with that used since 1970s

There has been much speculation that the cannabis being smoked by today’s young

people is stronger than that smoked by their parents. There is no Australian evidence

to this effect. However, young people are more likely to smoke cannabis through a

‘bong’ or ‘joint’ and there is evidence of a tendency to smoke the heads of the

cannabis plant as opposed to the leaves, compared with older users. These two factors

combine to increase young people’s exposure to higher levels of THC6.

6 Comparative Health Impact

Based on current use patterns, alcohol and tobacco are much more damaging than

cannabis to public health in developed countries. The most recent data on causes of

disease burden in Australia comes from a 1996 study that calculated disease burden

according to Disability Adjusted Life Years (DALYs) Lost8. DALYs incorporate years

lost to premature mortality and years lost to disability. The study found that for males,


alcohol dependence/abuse ranked number 13 on the list of causes compared with 70

for cannabis dependence/abuse. This translated to 31 million years of healthy life lost

or 2.4% of the total burden of disease for alcohol dependence/abuse, compared with 3

million years of disability and 0.2% of the total burden of disease for cannabis8. For

women, alcohol dependence/abuse ranked 17 on the list at 13 million years of healthy

life lost or 1.2% of the total burden of disease. Cannabis dependence/abuse did not

rank on the top 75 leading causes of disease burden for women8.

In 1998-99 the social costs of drug use (including direct costs such as health, crime

and loss of production etc, as well as intangible costs such as pain and suffering) were

calculated as part of the National Drug Strategy9. As a percentage of the total social

cost from all illicit drugs in 1998-99 (those for cannabis were not calculated

separately) was less than that for alcohol (17.6% compared with 22%). The costs from

tobacco use represented 61.2% of the total9.

Another aspect of the health impact is that drug use, including illicit drug use, is

closely associated with social and economic disadvantage10.

7 Cannabis and Mental Health

Any use of cannabis by people who have had previous psychotic symptoms/illness is

detrimental. When people are ‘stoned’ they can forget to take their medications.

Cannabis can also worsen delusions, mood swings, hallucinations and especially

feelings of paranoia. Cannabis can both trigger further episodes of psychosis and

other psychiatric illnesses, and complicate treatment.

Cannabis use is associated with poor outcomes in existing schizophrenia and may

precipitate psychosis in those with a predisposition11. It appears that using larger

amounts of cannabis, at an earlier age and having a genetic predisposition increases

the risk of developing schizophrenia4.

There has been a meta-analysis of several landmark prospective cohort studies

examining the causal link between cannabis use and psychosis11. These have used a

variety of cohorts from Sweden, the Netherlands and New Zealand that have

individually demonstrated a causal link. However, there are limitations in drawing a


united conclusion from these studies due to methodological differences and

limitations such as the:

Heterogeneous measure of psychosis/schizophrenia used;

Measures of cannabis use were based on self-reporting rather than clinical

data;

Variable information on other concurrent drug use that may have a

confounding effect on results; and

Studies not being able to rule out the possibility that cannabis use was a result

of emerging schizophrenia rather than a cause of it (based on the fact that

schizophrenia is usually preceded by a psychological and behavioural changes

in the years before diagnosis7).

The meta-analysis of prospective studies of cannabis was used to determine that the

pooled odds ratio was 2:1 and that cannabis was a component cause in the

development and prognosis of psychosis11.

Other researchers71213have reviewed these studies and concur that there is a causal

relationship between cannabis use and psychotic conditions. This association does not

prove that cannabis causes schizophrenia but that it is a component cause forming part

of a causal constellation7. Likewise, it is not a sufficient cause, that is not all people

who use cannabis in adolescence go on to develop psychosis7.

7.1 Cannabis and Depression

Less research has been undertaken on links between cannabis and depression than

those between cannabis and psychosis. Cross-sectional studies have mostly indicated

that the relationship between cannabis use and depression is at least partly explained

by family and personality factors, other drug use and marital status. Longitudinal

study design research has consistently concluded that depression does not predict

cannabis use but that cannabis use imparts a moderate risk for later depression,

particularly amongst adolescent girls6.


The research on cannabis use and suicide has produced mixed results although there is

some evidence to support that heavy cannabis use can pose a small additional risk of

suicide6.

7.2 Cannabis and Anxiety

As with depression, there has been little research examining the links between

cannabis use and anxiety. That available indicates cannabis use and anxiety disorders

occur at a greater rate than one would expect from chance. However, these results

seem to be largely moderated by other factors such as child and family issues, other

drug use and peer associations6.

8 Medical Uses of Cannabis

In December 2005, the Royal College of Physicians of London released a report of a

working party entitled Cannabis and cannabis-based medicines: Potential Benefits

and risks to health. It contends that the only two recognised medical indications for

the main psychoactive ingredient of cannabis, THC are:

The treatment of nausea and vomiting associated with chemotherapy; and

Counteracting the loss of appetite and cachexia associated with AIDS14

Other possible medical indications for cannabis are:

As a pain reliever;

Treating neurological disorders such as multiple sclerosis, spinal cord injury,

and some movement disorders, particularly where there is muscle spasticity or

tremor6; and

Reduction of intra-ocular pressure in glaucoma.

9 Cannabis and Legislation

The possession, use and supply of cannabis is illegal in all states and territories. Each

state and territory has its own civil or criminal penalties for cannabis offences. All

jurisdictions have some capacity for minor and early cannabis offenders to be diverted

from the legal system into educative and/or treatment programs. This means first time

offenders are unlikely to receive a criminal record with the concomitant deleterious

health and social impacts6.


9.1 Criminalisation and Health

It is often cited that criminal penalties will acted as a deterrent to use. There is no

evidence to support this. In “A Public Health Perspective on Cannabis and Other

Illegal Drugs15”, the Canadian Medical Association highlights the profound impact on

health status associated with having a criminal record. The presence of a criminal

record can severely limit employment prospects leading to poor health.

Evidence indicates that strict drug laws in general encourage people to take more

potent drugs and to consume them in unsafe ways. Prohibition also makes users less

likely to seek treatment when they get into difficulty16. “Prohibition is the cause of a

significant proportion of the health costs associated with illicit drug use and it hinders

the achievement of the objective of harm minimisation”(page 8)16. Research indicates

that the introduction of liberal drug laws may result in a slight increase in temporary

drug use but that it is unlikely to increase, and may even decrease, drug related health

costs16.

9.2 Harm Reduction

In this context, harm reduction can be defined as policies and initiatives which

primarily aim to reduce the adverse health, social and economic consequences of

mood altering substances to individual drug users, their families and their

communities5.

In addition, harm reduction initiatives are consistent with:

Supply and demand reduction (where these are assessed in terms of their

ability to reduce harm);

Support for abstinence (cessation in the case of cigarette smokers) and the

lowering of use of drugs by individuals or particular groups; and

An increase in use of drugs but decrease in harms they cause, to individuals,

families and communities.

Harm reduction encourages the examination of drug use in a multifactorial context,

where the relationship between the person and the drug, as well as the environment

and the circumstances in which the person is using the drug are viewed. This

approach examines factors involved in the drug use such as the availability of the


drug in the community and the broader social issues and inequalities that may give

rise to drug use.

The term ‘harm minimisation’ is sometimes used as an alternative to ‘harm reduction’

but in recent years the term has become increasingly muddied and diluted in its use as

it has been used to support conflicting goals.

10 Treatment Options

While the numbers of people seeking assistance for treatment of cannabis increases

and research indicates that cannabis can be addictive there has been little research on

the effectiveness of treatment options for cannabis misuse6. The research on

pharmacological interventions for cannabis withdrawal and craving is in its infancy

and there has been no randomised control trials in this area6.

Treatment options for cannabis dependence are much fewer than for alcohol or opiate

dependence. They generally include some form of psychological treatment such as

Cognitive Behaviour Therapy or Motivational Interviewing.

Australian and overseas studies provide some support for effectiveness for brief

intervention programs using these techniques. Several small studies with specific

population groups show some effectiveness for vouchers for retail products as an

incentive for cannabinoid free urine samples. Much of the literature focuses on

interventions with young people6.

It is important that doctors are aware of the harms that can occur from cannabis and to

engage in continuing education as the evidence regarding cannabis continues to

develop. Doctors, particularly general practitioners, are strategically placed to educate

people regarding the use of cannabis and to assist those with problems associated with

cannabis.

11 The AMA Position:

11.1 The Australian Medical Association does not condone the use of cannabis for

non-medical purposes – it is a harmful drug.


11.2 The Australian Medical Association believes that cannabis use, as will all licit

and illicit drug use, needs to be viewed in terms of social determinants and the

social gradient, whereby people living further down the gradient are at greater

risk of drug harms.

11.3 The Australian Medical Association considers cannabis use to be both a health

and social issue.

11.4 The Australian Medical Association considers cannabis as a drug that causes a

range of health and social harms at the individual and community level.

11.5 The Australian Medical Association supports a harm reduction approach to

cannabis use.

12 Harm from Cannabis

12.1 The Australian Medical Association believes that the harms associated with

cannabis use should be viewed along with the continuum of harms caused by

both licit and illicit drugs. The mental health and other harms to the individual

cannabis user can be debilitating. The absolute risk of harm to users is small

but there is a dose-response relationship with the more cannabis consumed the

greater the risk of experiencing harm.

12.2 The Australian Medical Association believes the response to cannabis use

should be one whereby cannabis users are diverted into education or treatment

programs. Law enforcement should target the suppliers of cannabis.

12.3 The Australian Medical Association supports the development and use of

evidence based harm reduction programs. Such programs need to be

thoroughly and prospectively evaluated.

12.4 The Australian Medical Association supports a public education campaign to

demonstrate that ‘soft’ or ‘recreational’ drugs, as any drug, can have serious

and harmful effects. This is particularly relevant for cannabis.


12.5 The Australian Medical Association supports the widespread availability of

appropriate evidence based information and education on cannabis,

particularly to young people.

12.6 The Australian Medical Association recognises that children can have

significant neurological effects as a result of accidental ingestion of cannabis.

Children should be protected from any exposure to cannabis. All doctors

should consider cannabis ingestion in a toddler or child with reduced

consciousness levels and with or without abnormal neurological findings.

13. Cannabis and Mental Health

13.1 The Australian Medical Association believes the current evidence supports

cannabis being a component cause in the development of psychosis. The

precise strength of this causal relationship is currently unknown. The AMA

recognises the role for further prospective population based cohort studies,

particularly of young people, to examine the strength of this relationship.

Cannabis use can aggravate mental illness in those who have a predisposition

or have a pre-existing mental illness.

13.2 The Australian Medical Association supports research, from both a genetic

and socioeconomic perspective, to identify those young people most at risk of

cannabis induced psychosis and the efforts that can be made to reduce that

risk.

13.3 The Australian Medical Association calls for suitable treatment and support

services for those who are affected by mental health consequences of cannabis

use, and their families.

14 Responses to Cannabis Use

14.1 The Australian Medical Association believes that doctors have an important

role in educating people about cannabis and supporting those with problems

associated with cannabis. The AMA calls for better links with primary care

and specialist mental health and drug and alcohol services. There is a need to

reduce barriers and improve services for those seeking treatment for problems

associated with cannabis.


14.2 The Australian Medical Association believes that responses to cannabis need

to cover protection, identification, diagnosis, treatment and rehabilitation.

14.3 Prevention

14.3.1 The Australian Medical Association believes that as younger people and those

who use cannabis frequently are most at risk of harm, early intervention

programs and initiatives to avoid, delay and reduce the frequency of cannabis

use are essential.

14.3.2 The Australian Medical Association believes that school based life skills

programs that are evidence based can assist in preventing or reducing

substance use problems. No child should be denied access to such programs.

14.3.3 The Australian Medical Association calls on government to undertake specific

initiatives to reduce the social inequalities that increase the risk of harm from

drug use to persons and communities who live further down the social

gradient.

14.3.4 The Australian Medical Association calls on government funding for harm

reduction to be increased to be at least equal to that currently allocated to use

reduction (law enforcement).

14.4 Identification

14.4.1 The Australian Medical Association encourages medical practitioners to be

aware of dual diagnosis (psychiatric and alcohol and drug disorder) issues and

multiple drug use problems when taking patient histories, especially of young

people.

14.5 Diagnosis

14.5.1 The Australian Medical Association encourages medical practitioners to be

aware of the diagnostic criteria for cannabis related disorders when assessing

and diagnosing patients identified as having a cannabis use problem.

14.6 Treatment


14.6.1 The Australian Medical Association calls on Government to fund research into

the best treatment methods, including the development of possible suitable

pharmacotherapies, for those who are dependent on cannabis or those who

wish to reduce or cease their use.

14.6.2 The Australian Medical Association calls for psychological and

pharmaceutical evidence based treatments to be available for those who wish

to decrease or cease their use of cannabis.

14.7 Rehabilitation

14.7.1 The Australian Medical Association believes that those with cannabis related

disorders require appropriate rehabilitative services as they manage their

disorder.

15 Medical Uses of Cannabis

15.1 The Australian Medical Association considers cannabis may be of medical

benefit in:

HIV-related wasting and cancer-related wasting; and

Nausea and vomiting in people with cancer, undergoing chemotherapy,

which does not respond to conventional treatments.

15.2 The Australian Medical Association believes that more research needs to be

undertaken to determine the medical benefit of cannabis in:

Neurological disorders including (but not limited to) multiple sclerosis and

motor neuron disease; and

Pain unrelieved by conventional treatments.

15.3 The Australian Medical Association supports research to examine whether

cannabinoids provide any greater benefit than the newer antimetics.

15.4 The Australian Medical Association considers that smoking or ingesting a

crude plant product is a harmful way to deliver cannabinoids. The AMA

supports more research into other ways of delivering cannabinoids as well as

their safety and efficacy in proven medical treatments.


15.5 The Australian Medical Association believes any promotion of the medical

use of cannabinoids will require extensive education of the public and the

profession on the harmful effects of non-medical use of cannabis.


References: 1 Hall, W. Degenhardt, L. and Lynskey, M. 2nd Ed. (2001) “The Health and

Psychological Effects of Cannabis Use” Monograph Series No. 44. Commonwealth

of Australia.

2 Drug Facts – Cannabis. DrugInfo Clearinghouse.

www.druginfo.adf.org.au/article_print.asp?ContentID=cannabis

3 Policy Positions of the Alcohol and other Drugs Council of Australia. September

2003.

4 Harris, A. “An Examination of the Links Between Cannabis Use and

Schizophrenia”. Engage. Issue 6 May 2006. Mental Illness Fellowship of Australia.

5 http://www.ihra.net/popups/articleswindow/php?id=2. Accessed 5 April 2006.

6 Copeland, J. Gerber, S. and Swift, W. (2006) Evidence-based Answers to Cannabis

Questions: A review of the literature, Australian National Council on Drugs.

7 Arsenault, L. Cannon, M. Witton, J. and Murray R.M. “Causal Association Between

Cannabis and Psychosis: Examination of the evidence”. British Journal of Psychiatry

(2004) 184, 110-117.

8 Mathers, C.; Vos, T. and Stevenson, C. (1999) The Burden of Disease and Injury in

Australia. Australian Institute of Health and Welfare, Canberra.

9 Collins, D.J. and Lapsley, H.M. (2002) Counting the Cost: Estimates of the social

costs of drug abuse in Australia 1998-9. Commonwealth of Australia.

10 Wilkinson, R. and Marmott, E. Eds (2nd Ed). (1998) Social Determinants of Health

– The Solid Facts. World Health Organisation.


11 Henquet. C.; Murray, R.; Linszen, D. and van Os. J. “The Environment and Schizophrenia: The role of cannabis use”. Schizophrenia Bulletin 2005 Jul; 31 (3):608-12. 12 Hall, W. “Cannabis Use and the Mental Health of Young People”. Australian and

New Zealand Journal of Psychiatry 2006; 40:105-113.

13 Fergusson, D.M.; Poulton, R.; Smith, P. and Boden, J.M. “Cannabis and

Psychosis”. British Medical Journal 2006; 332: 172-176.

14 Royal College of Physicians (2005) Cannabis and cannabis-based medicines:

Potential benefits and risks to health. RCP, London.

15 Canadian Medical Association. (2002) A Public Health Perspective on Cannabis

and Other Illegal Drugs. CMA Submission to the Special Senate Committee on

Illegal Drugs.

16 Macintosh, A. (2006) Drug Law Reform: Beyond Prohibition. The Australia

Institute.

Any questions regarding this submission should be directed to: Mr Andrew Took Director, Medico Legal and Employment Relations AMA (NSW) PO Box 121 St Leonards NSW 1590 Ph: 02 9439 8822 Fax: 02 9438 3760 Email: [email protected]

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